VINOD JAIN VS SANTOKBA DURLABHJI MEMORIAL HOSPITAL

MANU/SC/0267/2019

INTRODUCTION

The present case involved the sad and unfortunate demise of the appellant's wife who had
been admitted for treatment at the respondent hospital and was under the care of the
respondent doctor. Complex allegations and claims of professional negligence were levelled
by the aggrieved husband against the doctor and the hospital management regarding the
manner in which medical treatment had been administered during her hospitalization and the
circumstances culminating in her death soon after discharge. The appellant ardently believed
and was convinced that the tragedy which had befallen his wife was on account of negligent
medical care by the respondents. The matter eventually travelled up from the consumer
dispute redressal forums to the National Commission and finally to the Supreme Court of
India for authoritative adjudication on the contentious issues of alleged medical negligence
raised and determination of professional liability.

The Court was tasked with the duty of meticulously analyzing the factual matrix surrounding
the patient's treatment and death and application of established legal principles governing
assessment of negligence in medical care. The apex Court was required to provide justice to
the appellant while also balancing the rights of the doctor and hospital in cases where
negligence is sought to be imputed without adequate basis. The present case delved into
intricate issues of law pivoted around principles of assessing negligence and professional
liability in medical practice which called for nuanced appreciation.

FACTS

The appellant Vinod Jain's wife, Sudha Jain, had been suffering from multiple serious
medical conditions that had debilitated her health over the years. She had been diagnosed
with cancers of the colon, breast and oesophagus in the past for which she had undergone
surgeries, chemotherapy and radiotherapy. She was also a known case of hypertension and
type 2 diabetes which further compromised her health.
In October 2011, she developed symptoms of high fever with chills. She also faced an issue
of dysphagia making her unable to swallow food, due to which she needed insertion of a
nasal feeding tube. On 15.10.2011, she was admitted to the respondent Dr. Durlabhji
Memorial Hospital by her husband and came under the treatment of respondent Dr. Santokba.
Considering her symptoms, the doctor conducted some preliminary tests and started
intravenous antibiotic injections along with other medications. A nasal feeding tube was also
inserted by another doctor to facilitate feeding.

However, the next day, it was found that the intravenous cannula had become non-functional,
probably displaced or blocked. The respondent doctor examined the patient and took an
informed decision to not re-cannulate the patient for IV access, but instead prescribed oral
antibiotics, specifically Cefpodoxime tablets. The doctor also prescribed continuing other
medications and supportive care. After three days of in-patient treatment, the doctor decided
the patient was fit for discharge and she was discharged from the hospital on 18.10.2011.

Tragically however, just a few days later, the patient's condition deteriorated. She went into a
coma on 23.10.2011, requiring immediate hospitalisation again. Despite best efforts at the
new hospital, her condition continued to worsen, ultimately resulting in her death on
31.10.2011. The appellant husband and family were devastated at this sudden tragic loss.

The grieving husband strongly believed that his wife's death was a direct result of the
negligence, improper and inadequate treatment by the respondent hospital and doctor while
she was admitted there, who he held squarely responsible for her death. The appellant thus
initiated legal action against them.

ISSUES

 Whether the respondent doctor and hospital were guilty of medical negligence in their
treatment of the appellant's wife?

PROCEEDINGS BEFORE CONSUMER FORUMS AND COMMISSIONS

The aggrieved appellant first approached the Medical Council of Rajasthan seeking action
against the doctor and hospital. However, after a detailed investigation including scrutiny by
a panel of expert doctors, the Council dismissed his complaint finding no conclusive evidence
of negligence in the given facts. The appellant's further appeal to the Medical Council of
India was also rejected as being time-barred.

The appellant thereafter embarked on seeking legal recourse by filing a consumer complaint
with the appropriate State Consumer Disputes Redressal Commission. In his complaint, he
made detailed allegations of negligence against the hospital and doctor including lack of
proper care, inappropriate medication, stopping IV antibiotics, discharging the patient
prematurely despite her serious condition and overall deficiency in treatment leading to her
death.

The State Commission after examining the factual matrix, medical records and expert
opinion, upheld the appellant's complaint. It held that the doctor should have continued the
intravenous antibiotics instead of switching to oral medication when the patient's WBC
counts were high. It also found that discharging the patient when her infection markers were
elevated was unreasonable and negligent. Accordingly, it awarded substantial compensation
to the appellant.

Being aggrieved by the adverse findings, the hospital and doctor appealed before the National
Consumer Disputes Redressal Commission. After re-appreciating the facts and evidence, the
National Commission took a different view. It held that no negligence of the level alleged
was conclusively established based on the overall treatment protocol, condition of the patient
and expert guidance relied on by the doctor. It overturned the State Commission's order
awarding compensation. This led the appellant to file the present appeal before the Supreme
Court against the National Commission's order exonerating the hospital and doctor of
negligence. The apex Court was called upon to undertake final determination on this issue.

ARGUMENTS

The appellant made impassioned arguments alleging several acts of negligence by the doctor
and hospital. His foremost argument was that the doctor should have continued the
intravenous antibiotic injections instead of discontinuing it and switching to oral antibiotic
medication when the patient's WBC counts were abnormally high indicating an infection. He
contended that stopping IV antibiotics was contrary to standard medical practice in such a
situation where potent IV drugs were necessary to deal with the critical infection.
Secondly, the appellant strongly argued that his wife was prematurely discharged from the
hospital when her condition was in fact serious enough to warrant further in-patient care and
stabilization with intravenous medications. He claimed that discharging her at a stage when
her WBC count remained dangerously high amounted to professional negligence and
imperilling her health.

The appellant also submitted that over all the treatment meted out to his wife at the hospital
was inadequate, substandard and negligent which directly resulted in deterioration of her
condition upon discharge and her death within days. He argued that the lack of proper care
while admitted as an in-patient set off a chain of events leading to her death. On their part, the
hospital and doctor justified their line of treatment and decisions taken. They submitted that
prescribing oral antibiotics instead of IV medication was an exercise of professional
judgment solely guided by the patient's welfare based on a thorough evaluation of her vital
parameters and other health conditions. Her vitals were stable and she was well hydrated.
Thus, the doctor took a considered call that oral medication would suffice instead of
recannulating for IV drugs.

Similarly, they argued the decision for discharge was taken only after the doctor confirmed
the patient was medically stable enough for it and further in-patient care was not required. All
actions were bona fide and based on professional assessment of the patient's needs, not
negligence. Overall, the allegations of improper care were denied as baseless.

Thus, both sides presented impassioned arguments for and against the stand that medical
negligence was proven warranting damages.

FINDINGS AND DECISION OF THE SUPREME COURT

The Supreme Court meticulously analysed the factual matrix of the case along with the
medical treatment and decisions taken by the doctor. It evaluated the matter in light of
established legal principles and tests for determining medical negligence. The Court noted
that to prove negligence, it must be shown that the doctor did not possess the requisite skill
and competence required for the case, or did not exercise reasonable level of care and
diligence. Merely because the doctor chose one course of treatment over another acceptable
option would not make him negligent. The Court found that the concerned doctor did possess
the necessary skill, knowledge and experience required for treating the patient.
Regarding the allegation of stopping IV antibiotics, the Court found this was an exercise of
professional judgment taken by the doctor based on careful evaluation of the patient's
condition. When the IV cannula failed, the doctor had to take a call whether to subject the
weak patient to the painful process of re-cannulation or prescribe oral medication.
Considering her vitals were stable then, he found the oral drug sufficient. This decision was
guided by the patient's welfare and not negligence.

On the discharge, the Court analysed that according to the contemporaneous medical records,
the patient was found fit for discharge after days of in-patient care and antibiotics. Thus, the
doctor's decision could not be inherently unreasonable or negligent. At best, in retrospect, it
may seem an error of judgment. The expert medical opinion also did not conclusively
establish the doctor deviated from standard medical protocol. The cause of death was
multifactorial considering the illnesses the patient already suffered from.

Thus, the Supreme Court concurred with the findings of the National Commission that no
negligence of the level warranting damages was conclusively made out against the doctor and
hospital. It dismissed the appeal, while noting that sympathy cannot translate to legal remedy
without adequate proof as per law.

ANALYSIS

The Supreme Court correctly applied the accepted legal principles to assess medical
negligence in this case. As per law, negligence is not proven merely if the doctor chooses one
treatment approach over another acceptable option, if he acted in good faith in the patient's
interest based on his professional judgment and the patient's condition. The Court found the
doctor did possess the required skill and competence expected of his qualifications to treat
this patient. Discontinuing IV antibiotics and prescribing oral medication instead was an
informed decision considering the patient's stable vitals and difficult IV access. Similarly,
discharging the patient was as per the doctor's assessment of her improved condition. At best,
these decisions may seem erroneous in hindsight but they were guided by the patient's
welfare based on the doctor's evaluation at that time. No conclusive proof existed showing
the doctor deviated from standard medical protocol or acted unreasonably. The cause of the
patient's tragic death was multifactorial, including her previous illnesses. Her death could not
be attributed solely to the doctor's treatment in hospital without evidence. Thus, the Court
correctly concurred with the National Commission that the appellant failed to prove
negligence warranting legal action and damages. Sympathy alone cannot justify holding the
doctor negligent where he acted in good faith based on professional assessment of the
patient's condition and interest. The appeal was rightly dismissed.

CONCLUSION

In the unfortunate backdrop of the patient's serious pre-existing medical conditions which had
already endangered her health status, rendering her a medically compromised person, the
doctor's actions and decisions guiding the treatment protocol administered to her during her
brief hospitalization were guided by professional considerations aimed at her welfare and
recovery based on a bona fide professional assessment and clinical evaluation. The Supreme
Court rightly concluded that this was not a matter where medical negligence of a certain and
unimpeachable nature was conclusively demonstrated warranting imposition of liability and
award of damages.

While sympathizing with the pain and grief of the appellant on losing his wife, the law
clearly directs that doctors acting in good faith and guided solely by welfare of the patient
should be protected from unfair harassment even if in retrospect their actions may appear
wanting or ill-advised due to an unexpected adverse outcome. Imputing negligence where a
doctor only commits an inadvertent error of judgement while acting in the patient's benefit
would make the medical profession risky and unsafe. The appeal was thus correctly rejected
as the appellant could not establish through clear evidence that the doctor and hospital had
breached their professional duty of care expected at law.